In the last three decades, many efforts have been made to identify the best way to manage pregnancies associated with antiphospholipid antibody syndrome (APAS). In this issue of Journal of Postgraduate Medicine, Dadhwal et al.[1] present their experience in the management of pregnant women with APAS in a tertiary center. In this cohort of 42 gestations, an overall live birth rate of 85.7% was achieved. This excellent result was undoubtedly related to preconceptional APAS counseling, along with early antithrombotic therapy. Indeed, some investigators recommend preconcepcional aspirin because of its possible beneficial effect on early stages of implantation. [2] All patients in the series of Dadhwal et al.[1] were started on low-dose aspirin before pregnancy and, as mentioned by the authors, especially in women with early recurrent pregnancy loss, this may have been the key for their successful live birth rate.

However, despite the marked improvement in the prognosis of obstetric APAS, the incidence of severe late pregnancy complications, namely fetal growth restriction, preeclampsia and especially premature delivery, remains extremely high.[1] It would have been interesting if Dadhwal et al.[1] had compared them with their hospital overall rates. Further studies are needed to determine the exact dosage of heparin that optimizes fetal outcome [3] and the role of new therapeutic strategies, such as hydroxychloroquine, in the prevention of late obstetrical complications in APAS women. [4]

Overall, this paper provides a valuable contribution to the understanding of APAS pregnancy outcome in India. This is really a good news for women with antiphospholipid syndrome!